Complications in the first year following cataract surgery with and without IOL in infants and older children

Changes in refraction and ocular dimensions after cataract surgery and primary intraocular lens implantation in infants

PURPOSE

To study refraction and axial length changes after cataract extraction and primary intraocular lens (IOL) implantation in children younger than 1 year of age.

SETTING

Two regional hospitals.

METHODS

After determining the IOL power for emmetropia, 80% of the value was used to choose the IOL for implantation to counter anticipated myopic shift with age. The main outcome measures were changes in refraction and axial length 3 years after surgery.

RESULTS

Thirty-four eyes of 20 children (mean age 6.7 months +/- 3.9 [SD]) were studied. Refraction in the immediate postoperative period was +4.53 +/- 1.45 diopters (D). Three years after surgery, the mean refraction was -2.49 +/- 3.08 D (P<.001). Twenty-two eyes (64.7%) had surgery during the first 6 months of life (group 1) and had a shorter axial length at surgery (mean 18.92 +/- 1.32 mm) compared with 12 eyes (35.3%) that received surgery between 7 and 12 months (group 2, mean 20.29 +/- 1.00 mm) (P = .007). However, the final axial length was greater in group 1 (mean 22.67 +/- 1.04 mm) than in group 2 (mean 21.23 +/- 0.26 mm) (P = .019).

CONCLUSIONS

Primary IOL implantation is an option for children having cataract surgery in the first year of life. Significant myopic shifts occurred, and this seemed to be more pronounced in younger children. It appears that rethinking current strategies for IOL power calculation may be required to achieve more optimal refractive outcomes.

Updates on the Surgical Management of Paediatric Cataract with Primary Intraocular Lens Implantation

With the advent of modern surgical techniques, paediatric cataract has become much more manageable. Intraocular lens (IOL) implantation is the standard of care for patients over the age of 2 years. The use of IOL in young infants is still controversial. In addition, there are still unresolved issues, such as the minimum age at which IOL can be safely implanted, IOL power selection and IOL power calculation. The current trends in the management of the above challenges are discussed. Although numerous reports on the prevention and management of posterior capsule opacification have been published, there are ongoing intensive debates and research. Long-term postoperative complications like glaucoma and rhegmatogenous retinal detachment are problems that cannot be overemphasised and these issues are also reviewed. Key words: Congenital cataract, Intraocular lens, Posterior capsule opacification

Completion rate of primary posterior continuous curvilinear capsulorhexis and vitreous disturbance during congenital cataract surgery

PURPOSE

We sought to document the completion rate of primary posterior continuous curvilinear capsulorhexis during congenital cataract surgery and determine the incidence of disruption of vitreous face during this procedure.

METHODS

One hundred six consecutive eyes of patients undergoing posterior continuous curvilinear capsulorhexis (PCCC) during congenital cataract surgery were evaluated prospectively for completion of PCCC and disruption of vitreous face. PCCC was performed under high-viscosity sodium hyaluronate (Healon GV 1.4%) initiated with 26 g of cystotome and later completed with Kraff-Uttrata forceps by frequent grasping and regrasping of the flap. Completion of PCCC and disruption of vitreous face during the procedure was noted. Even in cases of disrupted vitreous face, PCCC was performed and completed with forceps and, later, disruption of vitreous face was managed with 2-port automated limbal anterior vitrectomy. The size of PCCC was measured. An Alcon AcrySof SA30AL was implanted in-the-bag if the PCCC was 4 mm or smaller and in the sulcus when the PCCC was larger than 4 mm.

RESULTS

The mean age of the 106 pediatric patients was 17 +/- 26 months (median, 6 months; range, 1 month to 8 years). PCCC was completed in all the eyes. Disruption of vitreous face during PCCC was noted in 5 of 106 (4.7%) eyes. The mean size of PCCC was 3.6 +/- 0.7 mm. A total of 98 (92.5%) had in-the-bag, and 8 (7.5%) eyes had sulcus implantation of IOL.

CONCLUSION

PCCC was completed in all eyes with minimal disruption of vitreous face in a well-controlled manner under high-viscosity viscoelastics.

Incidence and risk factors for glaucoma after pediatric cataract surgery with and without intraocular lens implantation

PURPOSE

We sought to report the incidence of glaucoma in the eyes of children who underwent cataract surgery with and without intraocular lens implantation and to report the risk factors for developing glaucoma.

METHODS

We undertook a retrospective review of pediatric cataract surgery charts, excluding traumatic cataract, aniridia and Lowe syndrome, steroid-induced cataract, lens subluxation, uveitis, retinoblastoma, radiation-induced cataract, retinopathy of prematurity, secondary IOL implantation, and patients with less than 1 month of postoperative follow-up.

RESULTS

After pediatric cataract surgery, 10 (3.8%) of 266 eyes with primary intraocular lens implantation were diagnosed with glaucoma, whereas 8 (17.0%) of 47 aphakic eyes were diagnosed with glaucoma. During the initial analyses, we noted that all of the patients who developed glaucoma underwent cataract surgery when they were 4.5 months or younger. For all patients who underwent surgery during the first 4.5 months of their life, the glaucoma incidence was 24.4% (10/41) in children with pseudophakic eyes and 19.0% (8/42) in age-matched children with aphakic eyes (risk ratio=1.1, CI=0.7-1.9; P=.555). In patients who underwent surgery during the first 4.5 months of their life, the average age of the patients who developed glaucoma was not significantly different than those who did not develop glaucoma in pseudophakic eyes (2.0 months+/-1.4 vs. 1.9 months+/-1.0, P=.700) or aphakic eyes (2.6 months+/-1.5 vs. 1.4 months+/-0.9, P=.070). The corneal diameter of the eyes that developed glaucoma versus eyes that did not was not significantly different in patients with pseudophakic eyes (P=.860) or aphakic eyes (P=.254). Glaucoma was diagnosed in patients at an average of 8.6 months and 117.9 months after cataract surgery in those with pseudophakic eyes and aphakic eyes, respectively.

CONCLUSIONS

Patients undergoing cataract surgery at an early age are at high risk for the development of glaucoma with or without an intraocular lens implant.

The natural history of glaucoma and ocular hypertension after pediatric cataract surgery

INTRODUCTION

We sought to define the prevalence and natural history of ocular hypertension and glaucoma for at least a 10-year period after pediatric cataract surgery.

METHODS

We conducted a prospective observational study of patients who received pediatric cataract surgery. Inclusion criteria included 2 directed ophthalmologic examinations performed at a minimum of 5 and 10 years after surgery.

RESULTS

A total of 63 patients (22 with bilateral cataracts and 41 with unilateral cataracts) were examined at a median of 15.1 year (range, 10.3-21.3 years) after surgery. A majority of the subjects had glaucoma or ocular hypertension (ie, 59%; 37/63). Nineteen percent (12/63) had glaucoma (5/22 with bilateral cataracts and 7/41 with unilateral cataracts). Approximately half (7/12) had developed glaucoma during the first 5-year observational period and the remainder (5/12) developed it during the following observational period. Forty percent (25/63) of the patients had ocular hypertension in at least one aphakic eye (9/23 with bilateral cataracts and 16/40 with unilateral cataracts). The rate of progression from ocular hypertension to glaucoma over a mean observational period of 7.2 years (range, 6.2-8.1 years) was 23% (5/22).

DISCUSSION

Patients who receive surgery for pediatric cataracts are at very high risk of developing ocular hypertension and glaucoma. Patients can develop late-onset glaucoma and ocular hypertension more than 10 years after surgery. Years of ocular hypertension may precede the diagnosis of late-onset glaucoma.

Modification of the high-speed vitrectomy system TSV 25 for pediatric cataract surgery

Modifications of a transconjunctival sutureless vitrectomy system (TSV 25, Bausch & Lomb Surgical) for removing cataracts and performing poster capsulotomy-anterior vitrectomy in children are reported.

Secondary intraocular lens implantation for pediatric aphakia

PURPOSE

We sought to report the outcome of secondary intraocular lens (IOL) implantation in children.

METHODS

This was a retrospective case review.

RESULTS

A total of 77 eyes were identified. An average age at secondary implantation was 7.8 +/- 5.0 years, whereas the average age at primary cataract surgery was 1.5 +/- 2.6 years. Average follow-up was 2.7 +/- 1.9 years. Thirty eyes received a hydrophobic acrylic IOL implantation whereas 47 eyes received a PMMA IOL. The sites of fixation for implanted IOLs were as follows: anterior-chamber (n = 6), sulcus (n = 42), in-the-bag (n = 14), optic-capture (n = 6), piggyback (n = 4), and sutured (n = 5). Complications included clinically significant decentration, 4 (5.2%); visual axis opacification, 4 (5.2%); dislocation of the IOL, 2 (2.6%); and pupillary capture requiring repositioning of IOL, 1 (1.3%). Clinically significant decentration requiring surgical intervention was noted only in eyes with sulcus-fixated foldable IOLs (28.6%; 4/14). None of the 29 eyes with sulcus-fixated PMMA IOL implantation developed decentration. All the decentrations were in an inferior direction and occurred in eyes of male patients (P = 0.03). Eyes with an axial length of >23 mm were 4 times more likely to develop decentration if implanted with a sulcus-fixated foldable IOL when compared with eyes measuring <23 mm (P = 0.03). Postoperative geometric mean visual acuity was significantly better than preoperative visual acuity (P < 0.001).

CONCLUSION

Secondary IOL implantation can be safely achieved in pediatric eyes. In-the-bag fixation of foldable IOLs is associated with a low rate of complications. Foldable lenses appear to have a higher rate of decentration than PMMA lenses when placed in the sulcus in eyes of myopic male patients.

Visual results after primary intraocular lens implantation or contact lens correction for aphakia in the first year of age

PURPOSE

The optimal role of intraocular lenses (IOLs) in infants remains a controversial topic. Some ophthalmologists advocate correction with a contact lens (CL), whereas others recommend an IOL correction. Our study compared visual acuity, ocular alignment, retreatment rate and binocular vision outcomes in children treated with these two methods at our clinic.

METHODS

This study included 41 children with unilateral congenital cataract who underwent cataract surgery with posterior capsulorhexis and anterior vitrectomy, coupled with (IOL group, n=18) or without (CL group, n=23) primary IOL implantation. All infants underwent the first surgery during the first 12 months of their life and they were operated on in the period from 1994 to 1999. The mean age at surgery was 3.11+/-2.65 months (range: 28 days to 11 months). All patients were prescribed the same half-time reduced occlusion therapy. Good cooperation of the parents and good compliance with patching were the necessary conditions to include a patient in the study. Between January and February 2003, the final visual acuity and binocular vision outcomes were examined.

RESULTS

The mean final visual acuity (logarithm of the minimum angle of resolution) of the operated eye was 0.43+/-0.33 for the IOL group and 0.58+/-0.39 for the CL group (p=0.14). The mean interocular difference in visual acuity was 0.22+/-0.29 for the IOL group and 0.56+/-0.31 for the CL group (p=0.042). The reoperation rate was 78% in the IOL group compared with 35% in the CL group (p=0.017). Esotropia or exotropia of more than 8 prism diopters were present in 55% of children (10/18) in the IOL group compared with 83% of children (19/23) in the CL group (p=0.039).

CONCLUSIONS

We suggest that correction of aphakia after unilateral congenital cataract surgery with primary IOL implantation results in improved visual acuity, improved binocular vision outcome and less occurrence of strabismus, but a higher rate of complications requiring reoperation. Further studies with a larger pediatric patient group are necessary to confirm the optimal treatment of aphakia after unilateral congenital cataract extraction.

After-cataract in children having cataract surgery with or without anterior vitrectomy implanted with a single-piece AcrySof IOL

PURPOSE

To evaluate whether cataract surgery in children should be performed with anterior vitrectomy and to examine the properties of the AcrySof SA30AL intraocular lens (IOL) in the pediatric eye.

SETTING

Filatov Institute, Odessa, Ukraine.

METHODS

Cataract surgery was performed in 66 children aged 3 to 15 years. They were randomized to surgery with or without anterior vitrectomy. All eyes were implanted with the single-piece AcrySof SA30AL IOL (Alcon). During the study, the patients who needed surgery for after-cataract had a second surgical procedure. Two years after surgery, the surgical method was evaluated using exact logistic regression. Also, the Evaluation of Posterior Capsule Opacification (EPCO) score was compared between the patients who had surgery for after-cataract and the patients who did not need this. The presence of posterior synechias and centration of the IOL were assessed.

RESULTS

Children in the younger age group (</=62 months at surgery) had surgery for after-cataract more often than children in the older age group (P<.01). Patients who did not receive an anterior vitrectomy had surgery for after-cataract more often (P<.01). Age at surgery and whether an anterior vitrectomy was performed did not significantly affect the EPCO score. The patients who had surgery for after-cataract had a significantly higher EPCO score (P<.001). The IOL remained centered in all eyes; no eye developed posterior synechias.

CONCLUSIONS

This prospective study shows that cataract surgery with anterior vitrectomy is advantageous in younger patients concerning after-cataract formation. The AcrySof SA30AL maintains good centration, produces minimal inflammation, and is well tolerated in the pediatric eye.

Accuracy of intraocular lens calculations in infants and children undergoing cataract surgery

PURPOSE

We sought to evaluate the accuracy of intraocular lens calculations in children undergoing cataract extraction with intraocular lens (IOL) implantation.

METHODS

This was a retrospective review of 101 consecutive cases of pediatric cataract extraction with posterior chamber IOL. Median age at the time of surgery was 4.8 years, and 23 of the children were younger than 2 years of age. Initial IOL calculations were made using either the SRK II or SRK T formulas. Preoperative predictive data were compared with the refractive result obtained at the 2-month postoperative visit. Prediction error was calculated for each patient, and lens calculation errors were back-calculated for each of 4 commonly used IOL calculation formulas, including the SRK II, SRK T, Holladay I, and Hoffer Q.

RESULTS

The mean prediction error for all patients was 0.30 D. Despite this level of overall accuracy, significant variability did occur with outcomes ranging from -4.06 D to + 3.86 D of the desired spherical equivalent. Mean absolute prediction error was 1.16 D with no significant difference between the SRK II and SRK T formulas. Lens calculation errors predicted by each of the 4 formulas studied demonstrated a high degree of variability with the SRK II being the least variable and the Hoffer Q being the most variable, particularly among the youngest group of children with the axial lengths less than 19 mm.

CONCLUSIONS

The accuracy of commonly used IOL calculation formulas is generally reasonable but highly variable within the pediatric population, Newer theoretic IOL calculation formulas did not outperform older regression models.

Optotype acuity and re-operation rate after unilateral cataract surgery during the first 6 months of life with or without IOL implantation

AIMS

To compare optotype acuities and re-operation rates in children corrected with a contact lens (CL) compared with an intraocular lens (IOL) following unilateral cataract extraction during infancy in a non-randomised, retrospective case series.

METHODS

25 infants with a unilateral congenital cataract underwent cataract surgery with (IOL group, n = 12) or without (CL group, n = 13) IOL implantation when <7 months of age. Optotype acuities were assessed in 19 of these children at a mean age of 4.3 years (range 3.3-5.5 years). The number of re-operations were assessed in 21 children.

RESULTS

The visual acuity results were similar in the two treatment groups (p = 0.99); however, two of the four (50%) children in the IOL group compared with two of the seven (28%) children in the CL group undergoing surgery during the first 6 weeks of life had 20/40 or better visual acuity. The children in the IOL group had more re-operations than the children in the CL group (mean 1.1 v 0.36). Most of the re-operations in the IOL group were membranectomies performed during the first year of life (median 8.0 months) whereas all of the re-operations in the CL group were the implantation of a secondary IOL later in childhood (mean 2.2 years).

CONCLUSION

Optotype acuities were similar for the children corrected with a CL compared with IOL, while the children in the IOL group underwent more re-operations .

Removal of dense posterior capsule opacification after congenital cataract extraction using the transconjunctival sutureless vitrectomy system

We report a case of posterior capsule opacity and anterior hyaloid opacity after congenital cataract extraction that was successfully and easily removed using the transconjunctival sutureless vitrectomy system (TSV 25, Bausch & Lomb Surgical). With the TSV25 system, clear axes were maintained.

Single-piece AcrySof in the newborn rabbit eye

PURPOSE

To evaluate the behavior of the single-piece AcrySof SA30AT intraocular lens (IOL) (Alcon) in the eyes of newborn rabbits and to compare the postoperative complications in aphakic and pseudophakic eyes.

SETTING

St. Erik's Eye Hospital, Stockholm, Sweden.

METHODS

Clear lens extraction was performed in both eyes of 20 3-week-old rabbits. In 1 randomly selected eye in each rabbit, a single-piece acrylic IOL was implanted. Preoperatively and 1 and 2 months postoperatively, axial length and corneal diameter were measured. Corneal thickness was measured at the endpoint. The rabbits were also examined clinically; the position of the IOL and signs of secondary glaucoma were noted. At 2 months, the 19 surviving animals were killed. In 10 rabbits, the wet mass of the after-cataract was measured, and the eyes of 9 rabbits were fixed in formalin for histologic evaluation.

RESULTS

One animal died soon after surgery. Three rabbits developed secondary glaucoma in the aphakic eye. No rabbit developed glaucoma in the pseudophakic eye. In the 16 animals without secondary glaucoma, there were no significant differences in corneal diameter at 1 and 2 months or in corneal thickness at the endpoint; the axial length was significantly longer in aphakic eyes at 1 month, but not at 2 months. The aphakic eyes developed more posterior synechias and the pupil size at 1 and 2 months was significantly smaller in aphakic eyes than in pseudophakic eyes. Significantly more after-cataract developed in aphakic eyes than pseudophakic eyes (eyes with secondary glaucoma included). No difference in inflammation was seen between eyes in the histologic evaluation. In 11 of 19 pseudophakic eyes, the anterior capsulorhexis was not completely on the optic. In these eyes, the optic moved partly forward into the anterior chamber.

CONCLUSION

The single-piece AcrySof SA30AT IOL seems to induce less inflammation and probably inhibits secondary glaucoma. It does not retard eye growth as much as previously tested IOLs. However, it is important to keep the entire capsulorhexis margin on the optic, especially in these small eyes.

Visual axis opacification after AcrySof intraocular lens implantation in children

PURPOSE

To evaluate visual axis opacification after AcrySof intraocular lens (IOL) (Alcon) implantation in pediatric eyes.

SETTING

Iladevi Cataract and IOL Research Centre, Ahmedabad, India.

METHODS

This prospective study evaluated 103 consecutive eyes of 72 children with congenital cataract. Two groups were formed based on age at surgery: Group 1, younger than 2 years, and Group 2, older than 2 years. All eyes in Group 1 (n = 37) had primary posterior continuous curvilinear capsulorhexis (PCCC) with anterior vitrectomy. In Group 2 (n = 66), management of the posterior capsule was assigned randomly to no PCCC (Group 2A, n = 37) or PCCC (Group 2B, n = 29). The PCCC group was further randomized into 2 subgroups: no vitrectomy (Group 2BN, n = 14) or vitrectomy (Group 2BV, n = 15). The primary outcome measures were visual axis opacification and the resulting need for a secondary procedure. Statistical analysis was performed using SPSS for Windows (version 11.0.1).

RESULTS

The mean age of the patients was 5.2 years +/- 5.0 (SD) (range 0.2 to 16.0 years) and the mean follow-up, 2.3 +/- 0.9 years (range 1.0 to 4.0 years). Overall, 41 eyes (39.8%) developed visual axis opacification and 14 (13.6%) required secondary intervention. In Group 1, 4 eyes (10.8%) developed visual axis opacification and 3 (8.1%) had a secondary pars plana vitrectomy. In Group 2A, 31 eyes (83.8%) developed posterior capsule opacification (PCO) and 10 eyes (27.7%) had secondary intervention. Children 8 years or younger at the time of surgery developed significantly greater PCO than older children (P =.01). Five eyes (37.5%) in Group 2BN had opacification of the anterior vitreous face, 1 of which required a secondary procedure. One eye (6.7%) in Group 2BV had visual axis opacification that did not require a secondary procedure.

CONCLUSIONS

AcrySof IOL implantation with appropriate management of the posterior capsule maintained a clear visual axis in 60.2% of eyes. Of the 39.8% of eyes with visual axis opacification, 13.6% had visually significant opacification and required a secondary procedure.

Opacification of the visual axis after cataract surgery and single acrylic intraocular lens implantation in the first year of life

PURPOSE

To report the incidence and risk factors for secondary surgical intervention to treat visual axis opacification (VAO) after cataract surgery and acrylic intraocular lens (IOL) implantation during the first year of life.

METHODS

A retrospective review of 29 eyes of 20 patients receiving a hydrophobic acrylic (AcrySof; Alcon, Fort Worth, TX) IOL implantation was conducted. All eyes underwent primary posterior capsulectomy and anterior vitrectomy. Statistical analysis was performed using SPSS for Windows (SPSS, Chicago, IL).

RESULTS

Average age at surgery was 4.8 +/- 3.7 months, and average follow-up was 33.4 +/- 16.1 months. Eleven of 29 (37.9%) eyes developed VAO requiring secondary surgical intervention at a median of 4.8 months (95% confidence interval 3.4 to 6.2). Average age at surgery for eyes that subsequently opacified was 3.8 +/- 3.0 months compared with 5.4 +/- 4.0 months for those whose visual axis remained clear (P = 0.26). The relative risk of subsequent VAO surgery was 2.7 for primary surgery performed at or before the first 6 months of life. Opacification was significantly related to eyes with associated ocular anomalies (eg, anterior segment dysgenesis, iris hypoplasia, or persistent fetal vasculature) with a relative risk of 8.6 (P < 0.001). Proliferation of cortex was the most common form of VAO, followed by mixed-type with predominantly fibrous, fibrous alone, or Elschnig pearls. When secondary surgery was required, it occurred primarily during the first 6 months (ie, 9 of 11 patients) after the initial cataract surgery.

CONCLUSIONS

When cataract and IOL surgery was undertaken within the first year of life, a secondary surgical procedure was required in 37.9% of eyes to maintain a clear visual axis. Most secondary surgery for VAO occurred within the first 6 months after surgery. Postoperative opacification was most common in eyes with associated ocular anomalies.

Long-term follow-up of eye growth in pediatric patients after unilateral cataract surgery with intraocular lens implantation

PURPOSE

To evaluate the refractive status, axial length, and refractive power of the cornea in pediatric patients after unilateral cataract surgery and intraocular lens implantation.

METHODS

Refractive state, refractive power of cornea, and axial length were measured both in the operated and nonoperated eyes in 15 patients (age at surgery = 5 to 15 years; mean, 10.3) before and 4 to 15 years (mean, 9.7) after unilateral cataract surgery.

RESULTS

After surgery, visual acuity was 20/40 or better in 79% of operated eyes. Myopic changes, representing the difference between postoperative refraction at last follow-up and postoperative refraction at 1 year after surgery, were noted in the operated eyes at the end of study (mean, -5.02 D), but there were no significant differences in axial length (Wilcoxon signed rank test P >.05) or refractive power of the cornea between operated and nonoperated eyes (paired Student t test P >.05).

CONCLUSION

Myopic shift after cataract surgery with intraocular lens implantation may occur even in older children.

Intraocular lens implantation during infancy: perceptions of parents and the American Association for Pediatric Ophthalmology and Strabismus members

BACKGROUND

To determine whether a randomized clinical trial, the Infant Aphakia Treatment Study, comparing intraocular lens (IOL) implantation with contact lens (CL) correction for infants with a unilateral congenital cataract (UCC), is feasible by (1) ascertaining whether American Association for Pediatric Ophthalmology and Strabismus (AAPOS) members have equipoise regarding these two treatments and (2) evaluating the willingness of parents to agree to randomization.

METHODS

All AAPOS members were surveyed in August 1997 and again in June 2001 regarding their use of CLs and IOL implants to correct infants vision after unilateral cataract surgery. In addition, a pilot study was begun in March 2002 to evaluate the safety of IOL implantation during infancy and the willingness of parents to randomize their children with a UCC to either IOL implantation or CL correction.

RESULTS

In 1997, 89% of the 260 respondents reported that in the previous year they had treated at least one infant with a UCC, but only 4% had implanted an IOL in an infant <7 months old. Silsoft (Bausch & Lomb, Rochester, NY) CL correction was the preferred treatment choice for 84% of the respondents. In 2001, 21% of the 279 respondents had implanted an IOL in an infant. On a scale from 1 to 10 with 1 strongly favoring an IOL implant and 10 strongly favoring a CL, the median score was 7.5. Sixty-one percent of the respondents indicated that they would be willing to randomize children with a UCC to one of these two treatments. The main concerns about IOL implantation were poor predictability of power changes, postoperative complications, inflammation, and technical difficulty of surgery. The main concerns about CL correction were poor compliance, high lens loss rate, high cost, and keratitis. In our pilot study, 30 infants <7 months of age were evaluated at nine clinical centers for a visually significant UCC. Of 24 infants eligible for randomization, the parents of 17 (71%) agreed to randomization.

CONCLUSIONS

Although most AAPOS members still favor CL correction after cataract surgery for a UCC, five times as many had implanted an IOL in an infant in 2001 compared with the number in 1997. Parents were almost equally divided in their preference for IOL implant versus CL correction. Given the relative equipoise of AAPOS members regarding these treatments and the willingness of more than two thirds of parents to agree to randomization, it seems likely that a randomized clinical trial comparing these two treatments could indeed be conducted.